Provider Demographics
NPI:1477692655
Name:TISCHNER, KIMBERLY (DO)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:TISCHNER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 SOUTH MAIN STREET
Mailing Address - Street 2:EYECARE PYHSICIANS & SURGEONS OF NJ
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055
Mailing Address - Country:US
Mailing Address - Phone:609-654-6140
Mailing Address - Fax:609-953-2257
Practice Address - Street 1:73 S MAIN STREET
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055
Practice Address - Country:US
Practice Address - Phone:609-654-6140
Practice Address - Fax:609-953-2257
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00539200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5863156OtherAENTNA US HEALTHCARE
U57597Medicare UPIN
NJ5863156OtherAENTNA US HEALTHCARE